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a <br /> PEr�MIT APPLIC/�TIOtv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S�� g�7 <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> i I;a i� rH A �� ' CVEPE� W {�_j7 i � � � >�i nJ',J <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYrIP PHONE <br /> —�Z� v � r,�,.� A r�ti�h���,ic� � �sP�zEsso yas �� � - � a�a <br /> TEi..iNT NAME I CONTACT FOR PERMIT PHONE <br /> �/+ �� LS �ESJ�/1 �) � <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILCiNG I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas_Other <br /> WORK DESCRIPTION � E �ir b �/ L L U F C �( / S T I/�l G I�c/%} LL `�j � ��D <br /> ,zE �vcnrE / - 000x�. ' <br /> . . <br /> • PLUMBIN ` •• � • � • ' MEC�ANICAL � <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling'units.: <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas pipin� <br /> Shower Waler healer <br /> Kilchen sink&disposal _ Gas Tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> � Water heater Range hood <br /> Sink (service/bar/mop/etc.) _ Exhausl fan <br /> BackOow preventer _ Healpump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodslove <br /> = Ruof dra�c, I = Olher _ i <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I hereby ceritity that I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or nol The granting of a permit does not presume <br /> to give authoriry to violale or cancel lhe provision of any other slate or local law regulating r,onstruction or lhe performance o( <br /> construclion.That I am authorized by lhe owner of this property lo peAorm lhe work for which applicalion is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> cG � .Pi� �k1/ .�/I'1') �•L� 5/� 9 � � 7 <br /> Sig Wre o wnedContraclor/Authorized Agent Date _ / <br /> �� <br />